Gastroenterology Coding Alert

Question: I read your article last month regarding modifier audits with great interest. In particular, you mentioned that insurers are planning to audit modifier 24. We just used this modifier for the first time and now we’re worried we may have used it wrong. Can you offer a breakdown of how to use it?

Minnesota Subscriber

Answer: You will report modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) when the provider examines a patient within the 90-day global period of a major procedure, but for a different problem.

When you report modifier 24, the E/M service must meet these criteria:

• The E/M service occurs during the postoperative period of another procedure.
• The current E/M service is unrelated to the previous procedure.
• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.

Example: The physician performs hemorrhoid cautery (46930, Destruction of internal hemorrhoid(s) by thermal energy (eg, infrared coagulation, cautery, radiofrequency)) on a patient with private insurance. The service carries a 90-day global period. Two weeks later, the patient returns to the office with nausea and epigastric pain. The physician performs a problem-focused history and examination with straightforward decision making, and determines the patient has developed severe GERD that’s unrelated to the hemorrhoid or the surgery.

In this case, you’d report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) with modifier 24 appended.